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The Competition and Markets Authority has accepted that financial pressures on the NHS have “dampened the role of competition”, and says the impact on patient choice of the proposed merger of two large teaching trust in Manchester is “likely to be limited”.

An investigation by the competition regulator into the proposed merger of Manchester’s teaching hospitals should be viewed in the context of the financial deterioration and reduced autonomy of NHS foundation trusts, they have argued.

Clinical commissioning group mergers must create footprints that help deliver sustainability and transformation plans, and which are “future proofed” for the emergence of accountable care providers, under new NHS England guidance.